Provider Demographics
NPI:1881084549
Name:BI-LO PHARMACY
Entity type:Organization
Organization Name:BI-LO PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFF PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:DEVERELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:706-861-6197
Mailing Address - Street 1:820 MISSON RIDGE RD.
Mailing Address - Street 2:
Mailing Address - City:ROSSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30741
Mailing Address - Country:US
Mailing Address - Phone:706-861-6197
Mailing Address - Fax:
Practice Address - Street 1:820 MISSON RIDGE ROAD
Practice Address - Street 2:
Practice Address - City:ROSSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30741
Practice Address - Country:US
Practice Address - Phone:706-861-6197
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-02
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA023926333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy